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Reference: Staplin, N, Haynes, Richard, Herrington, William et al., (2015). Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP). American Journal of Kidney Diseases.Citable link to this page:


Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)

Abstract: Background: The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. Study Design: Observational study. Setting & Participants: 9,270 participants with CKD enrolled in SHARP. Predictor: Baseline smoking status (current, former, and never). Outcomes: Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality. Results: At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, -1.77±0.14 [SE]; never smokers, -1.70±0.07mL/min/1.73m2 per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality. Limitations: Smoking status not assessed during follow-up. Conclusions: In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.

Publication status:PublishedPeer Review status:Peer reviewedVersion:Publisher's versionAdmin:journal-article Funder: Medical Research Council   Notes:© 2016 The Authors. Published by Elsevier Inc. on behalf of theNational Kidney Foundation, Inc. This is an open access article publishedunder the CC BY license (, which permits unrestricted use, distribution, and reproduction in any medium,provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,and indicate if changes were made.

Bibliographic Details

Publisher: Elsevier

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Journal: American Journal of Kidney Diseasessee more from them

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Issue Date: 13 November 2015Identifiers


Issn: 1523-6838

Issn: 0272-6386

Uuid: eab42597-67ac-46b2-a3fa-ec75b3116ef1

Urn: uri:eab42597-67ac-46b2-a3fa-ec75b3116ef1

Pubs-id: 619748 Item Description

Type: journal-article;

Language: ENG

Version: Publisher's versionKeywords: Cigarette smoking Study of Heart and Renal Protection (SHARP) cancer cause-specific mortality chronic kidney disease (CKD) disease progression end-stage renal disease (ESRD) estimated glomerular filtration rate (eGFR) risk factor tobacco vascular events vascular morbidity


Autor: Staplin, N - - - Haynes, Richard - Oxford, MSD, Nuffield Department of Population Health, Clinical Trial Service Unit - - - Herri



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